Reducing Cancer Risks and Improving Outcomes
October 16, 2019
by BCCT advisor Ted Schettler, MD, MPH
Cancer Incidence and Trends
The National Cancer Institute lists more than 100 kinds of cancer. Their incidence varies by country, region, gender, age and occupation. In the US, men and women have about a one-in-three chance of developing cancer in their lifetimes. Childhood cancer is rare but it is the leading cause of death by disease in children past infancy.
Trends in cancer incidence also vary by country; aging populations only partially explain them. More importantly, changes in individual behavior, environmental, nutritional, biologic, and social risk factors collectively cause increases in some kinds of cancer and decreases in others.
Cancer control begins with prevention and extends through detection, diagnosis, and treatment. With so many kinds of cancer, the specific details for each stage vary considerably, but some concepts generally apply to all.
Cancer prevention advice for various kinds of cancer is based on knowing or assuming that reducing established or suspected etiologic risk factors will lead to a reduction in cancer incidence. We know this is true, for example, with tobacco smoking and lung cancer incidence. Sometimes though, the evidence may not be as strong—particularly when multiple causes each contribute more modestly to cancer risk, but collectively they add up to explain the origins of particular cancers.
Create the systems conditions in which cancer is less likely to develop and which improve the outcome when it does.[
Ecologic Framework of Health
Multi-level interventions can be combined in integrated disease-prevention strategies.
In addition to cancer prevention and treatment, an ecologic framework of health can also help us to understand more clearly trends in asthma, neurodevelopmental disorders, diabetes, obesity, autoimmunity and other complex diseases of our time. Single cause-and-effect relationships rarely explain them. Rather, the way we live, eat, move around, relate to one another, make and use consumer products, and interact with the natural world and resources together strongly influence health and disease patterns. Interactions among progressively nested individual-, family-, neighborhood-, community-, economic-, political- and societal-level variables are all involved.
We have a long history of simplifying complex problems into more manageable pieces to study them and deciding how to respond. That’s understandable, but if it prevents us from reassembling the pieces and recognizing them as systems problems requiring systems-level responses, this approach is not enough. Multi-level interventions can be combined in integrated disease-prevention strategies, just as integrated approaches to care and treatment of complex disorders holds promise for improved outcomes. Those are the challenges and opportunities.
- Ted Schettler, MD, MPH, Science & Environmental Health Network: